Simultaneous removal of impalpable implants in both the left and the right arm - a case report and implications for their use in low-resource settings.

Implanon NXT^® is a single rod contraceptive implant that is a long-acting reversible contraceptive method. Placement and removal is usually simple if the instructions of use are followed. Deviation from these instructions may lead to the implant becoming impalpable and consequently difficult to remove. We report on a case of a 46- year- old woman who had an impalpable implant in both the left and the right upper arms simultaneously. They had been placed approximately ten and seven years previously and were probably not releasing etonogestrel and were no longer relied on for contraceptive efficacy. The implants were removed relatively easily after ultrasound mapping. This case highlights some of the problems with the provision of implants in low-resource settings. The problems of implant management and some practical suggestions regarding its use in these settings is discussed.